Clinical diagnosis of fungal infections can be perplexing due to difficulty identifying symptoms and inconclusive results from tests like CT scans and X-rays. The gold standard for laboratory diagnosis is microscopy and culture, though culture can take days to weeks and samples from deep infections are often negative. Molecular diagnosis using PCR is more sensitive and specific than other methods but specialized techniques are still needed for rapid diagnosis. Clinical diagnosis considers characteristics lesions but they can resemble other diseases, while systemic infections show no specific fungal symptoms. Modern imaging and examinations have improved accuracy but diagnosis of invasive fungal diseases remains challenging.

1. CLINICAL DIAGNOSIS OF FUNGAL INFECTIONS
ANU SWEDHA ANANTHAN
ASSOCIATE PROFESSOR, DEPARTMENT OF MICROBIOLOGY,
JUSTICE BASHEER AHMED SAYEED COLLEGE FOR WOMEN, CHENNAI
Diagnosis of fungal infections are generally perplexing owing to the difficulty in identification of
the clinical symptoms if any and inconclusiveness associated with non-invasive methods like CT
scanning and X-ray diagnosis. The gold standard in laboratory diagnosis of fungal infections is
microscopy and culture. But culture generally takes about few days to few weeks and blood and
deep tissue specimens from infections with focal lesions are usually negative. Pathological
examination and microscopy may help in preliminary identification of the fungi but are does not
allow identification up to the species level. Though advanced technologies like employing
monoclonal antibody based ELISA to detect circulating Aspergillus and Candida antigens are
specific, they lack sensitivity. Molecular diagnosis using PCR is of important diagnostic value
and more sensitive and specific techniques are required for rapid diagnosis.
The diagnostic approach to fungal infections is based on the combination of
A) Clinical Diagnosis
B) Laboratory Diagnosis
A) CLINICAL DIAGNOSIS
 Clinical manifestations of fungal infections help in presumptive diagnosis of the type of
infection.
 Superficial and subcutaneous mycotic infections often produce characteristic lesions that
strongly suggest their fungal etiology but in some cases, the disadvantage is that these
lesions can closely resemble other diseases.
 Sometimes, the appearance of lesions has been considerably modified and rendered
atypical by prior therapy with topical steroids or other medicines. In case of systemic
mycosis there are no signs or symptoms that specifically suggests a fungal disease.
 Early diagnosis of fungal infections by the clinicians can increase the chance of
successful treatment. The physician should be thoroughly aware of the emerging and

2. commonly prevalent fungal infections and the possibility of a fungal involvement should
be considered right from the start.
 Using modern imaging techniques like Ultrasound, Computed Tomography scanning,
Magnetic Resonance Imaging, PET and X-rays for patient’s evaluation has improved the
accuracy and speed of diagnosis. Echocardiography has been used for detecting fungal
hyphae on heart valves and eye examination has been helpful in detection of
endophthalmitis caused as a result of systemic candidiasis.
 However, though the clinician’s knowledge and evaluative strategies have improvised
clinical diagnosis of fungal infection especially in relation to the superficial and
subcutaneous fungal mycosis, diagnosis of invasive and opportunistic fungal diseases still
remains a challenge.